Isotretinoin therapy: Completion rates and factors associated with nonadherence

Isotretinoin therapy: Completion rates and factors associated with nonadherence

2991 3266 Isotretinoin therapy: Completion rates and factors associated with nonadherence Tiana Kazemi, David Geffen School of Medicine, University o...

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3266 Isotretinoin therapy: Completion rates and factors associated with nonadherence Tiana Kazemi, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States; Suzanne Sachsman, MD, Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States; Holly Wilhalme, MS, UCLA Department of Medicine Statistics Core, Los Angeles, CA, United States; Carolyn Goh, MD, Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States Background: Isotretinoin is the gold standard treatment for severe recalcitrant nodular acne and acne that is refractory to other treatments. Therapeutic success depends on reaching a target dose over several months, which may be difficult to accomplish due to the need for iPLEDGE compliance and strict monthly follow up. Objectives: The present study examines isotretinoin adherence at an academic center and explores factors associated with nonadherence. Adherence was defined as reaching target cumulative dose (120-150 mg/kg) or completion of therapy as determined by the treating clinician. Methods: The medical records of 544 patients prescribed isotretinoin between 2010-2015 at UCLA Dermatology Clinic were reviewed. Exclusion criteria included current ongoing therapy, incomplete records, record access restriction and chronic low-dose therapy. Logistic regression, the Student t test, and the Chi-square test were used to analyze study data. Results: Of the 392 patients (51% female) who met inclusion criteria, 67% demonstrated adherence. For every year in age, odds of nonadherence increased by 3% (OR 1.03; 95% CI 1.01-1.06). Sex and previous isotretinoin courses did not significantly affect adherence (P ¼ .32 and P ¼ .11, respectively). Of the 130 nonadherent patients, 56% (n ¼ 73) were lost to follow-up with almost one-third dropping out during the first month of treatment (n ¼ 22). Of the remaining patients, 27 self-discontinued therapy. The most commonly cited causes were side effects (n ¼ 7), not starting therapy after receiving the prescription (n ¼ 6), mood changes (n ¼ 4), and iPLEDGE difficulties (n ¼ 4). Physician recommended discontinuation was seen in 21 patients, with side effects (n ¼ 8), elevated laboratory values (n ¼ 5), and mood changes (n ¼ 5) cited as the most common reasons. Therapy was paused by the physician in 12 patients, with elevated laboratory values (n ¼ 4) and GI bleeding/pain (n ¼ 3) reported as the most common causes. Of these patients, only 3 resumed and completed therapy. Conclusions: In contrast to published literature, our study indicates that adherence is not associated with sex or previous isotretinoin courses. Furthermore, we found that younger patients were more likely to complete therapy, perhaps due to greater involvement of parents in adolescent healthcare. Lastly, given the high dropout rate during the first month of therapy, improved patient screening and close attention to first follow-up appointment scheduling may be critical in increasing adherence rates. Commercial support: None identified.

2525 How is the severity of hidradenitis suppurativa measured in clinical practice? Murali Sundaram, AbbVie Inc, North Chicago, IL, United States; Peggy Lin, Analysis Group, Inc, Boston, MA, United States; Darren Thomason, Analysis Group, Inc, Boston, MA, United States; James Signorovitch, Analysis Group, Inc, Boston, MA, United States Introduction & objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by recurrent, painful skin lesions and significant negative impacts physically and psychologically. Hurley stage and Sartorius scale are two severity measures defined in the literature and used in clinical studies. However, evidence is scarce on the real-world use of HS severity measures in clinical practice. This study examined physician-reported use of HS severity measures in the US using a dermatologist survey. Materials & methods: A web-based survey was conducted among 20 dermatologists recruited from a physician panel. Included physicians were asked to report the number of HS patients that they had cared for during the past year, and indicate which severity measures they routinely recorded in the medical charts for HS patients. Results: Among the dermatologists surveyed, 80% were male and the majority was based in the South (60%) or West (35%) regions of the country. The median number of years in practice was 15, and the median number of all patients seen in the past year was 4400. Counts of abscesses (70%), counts of inflammatory nodules (50%), counts of draining fistulas (45%), and Hurley stage (20%) were the most commonly used methods for assessing HS severity. A Physician’s Global Assessment scale (10%) was sometimes used, and Sartorius scale (0%) was not routinely used. Notably, 15% of the surveyed dermatologists reported not routinely using any severity measure for HS. Conclusions: Based on physician report, the most frequently used HS severity measures in the US included counts of inflammatory nodules, abscesses, and draining fistulas, followed by Hurley stage and Physician’s Global Assessment. A substantial proportion of physicians did not routinely record any HS severity measure. The importance of severity monitoring in HS is expected to increase as new systemic treatments become available. Design, study conduct, and financial support for the study were provided by AbbVie; AbbVie participated in the interpretation of data, review, and approval of the abstract; all authors contributed to the development of the publication.



3265 Large scale survey to describe acne management in Brazilian clinical practice Sophie Seite, PhD, La Roche-Posay Dermatological Laboratories, Asnieres Cedex, France; Clarice Caixeta, PharmD, La Roche-Posay Dermatological Laboratories, Rio de Janeiro, Brazil; Loan Towersey, PhD, AIDS Division, Hospital Municipal Carlos Tortelly, Niter oi/Rio de Janeiro, Brazil Background: Acne is a chronic disease of the pilosebaceous unit that mainly affects adolescents. It is the most common dermatologic problem, affecting approximately 80% of teenagers between 12 and 18 years old. Diagnosis is clinical and based on the patient’s age at the time the lesions first appear, and on its polymorphism and type of lesions and their anatomic location. The right treatment for the right patient is key to treating acne safely. The aim of this investigational survey was to evaluate how Brazilian dermatologists in private practice currently manage acne. Methods: Dermatologists practicing in 12 states of Brazil were asked how they manage patients with grades I, II, III, and IV acne. Each dermatologist completed a written questionnaire, about patient characteristics, acne severity, and the therapy they usually prescribe for each situation. Results: In total, 596 dermatologists were interviewed. Adolescents presented the most common acneic population received by dermatologists, and the most common acne grade was grade II. The doctors could choose more than one type of treatment for each patient, and treatment choices varied according to acne severity. A great majority of dermatologists consider treatment with drugs as the first alternative for all acne grades, choosing either topical or oral presentation depending on the pathology severity. Dermocosmetics are chosen mostly as adjunctive therapy and its inclusion in the treatment regimen decreases as acne grades increase. Conclusion: This survey illustrates that Brazilian dermatologists employ complex treatment regimens to manage acne, choosing systemic drugs and particularly isotretinoin even in some cases of grade I acne and heavily prescribed antibiotics. Although treatment strategies for acne are complex, regimens practiced in this survey are harder for patients to comply with and may compromise adherence, which is a key factor in successful treatment. Supported by La Roche-Posay Dermatological Laboratories.

MAY 2016